Idiopathic Foveal Cavitation in a Pediatric Patient: Multimodal Imaging Findings Mimicking Early Macular Hole Formation

Macular holes are uncommon in pediatric patients and are most often associated with ocular trauma. Idiopathic cases are rare and may present as subtle clinical findings and atypical imaging features. We report a case of a 13-year-old boy presenting with decreased visual acuity in the left eye. Best-corrected visual acuity was 1.0 in the right eye and 0.5 in the left eye, with unremarkable anterior segment examination. Optical coherence tomography showed a foveal defect characterized by a central hyporeflective cavity with disruption of retinal layers, without evidence of a full-thickness defect. Fluorescein angiography demonstrated central hyperfluorescence without leakage. Color fundus photography revealed a subtle central foveal lesion, while electrophysiological testing and visual field examination were within normal limits. This case highlights that early structural abnormalities of the fovea in pediatric patients may present with minimal clinical findings and preserved retinal function. Multimodal imaging, particularly OCT, plays a key role in detecting subtle foveal alterations and may aid in identifying early stages within the spectrum of macular hole formation. Careful monitoring is warranted due to the potential for progression.